Reviewed By
Consultant Pediatric Dentist and MDS in Pediatric Dentistry, with over 10 years of experience at Kidz N Teenz Dental Clinic. Dr. Aysha Mansoor specializes in interceptive orthodontics, conscious sedation, and care for children with special needs.
When your child has a dental injury or an infection in a young permanent tooth, it can be worrying — especially when that tooth hasn’t finished developing. Fortunately, there’s a well-established treatment used to save these teeth: apexification in pediatric dentistry. This guide walks you through what it is, when it’s needed, how it’s done, and what to expect afterward.
What is Apexification in Pediatric Dentistry?
Apexification in pediatric dentistry is a procedure used to save an immature permanent tooth — one that hasn’t finished forming its root — when the nerve inside has died due to trauma or deep decay.
Why Root Development Matters
A permanent tooth’s root normally keeps growing and thickening for two to three years after the tooth erupts into the mouth. If the internal nerve (pulp) dies before that growth is complete, root development stops. The tooth is left with thin, fragile walls and a wide-open root tip, called the apex.
What Apexification Does
Rather than removing the tooth, apexification encourages the body to form a hard, calcified barrier across that open root tip. This barrier:
- Allows the root canal to be sealed properly
- Stops infection from spreading into the surrounding bone
- Lets your child keep their natural tooth instead of losing it early
Apexification vs. Apexogenesis in Children
Parents often hear both terms and assume they’re the same thing — they aren’t.
| Apexification | Apexogenesis | |
| Used when | Pulp (nerve) is already dead (non-vital) | Pulp is still alive (vital) but partly injured |
| Goal | Create an artificial barrier at the root tip | Preserve healthy pulp so the root keeps growing naturally |
| Root growth | Stops; barrier is induced instead | Continues naturally |
When is Apexification Treatment for Children Needed?
Your child may need this treatment if:
- They’ve had a fall or blow that damaged a front tooth
- There’s swelling, a pimple-like bump, or discharge near a newly erupted permanent tooth
- A deep cavity has reached the nerve of a young, still-developing tooth
- The tooth has darkened in color, signaling nerve damage
- Traditional root canal treatment isn’t possible because the root is too immature to seal
Most cases involve the upper front teeth in children between roughly 6 and 12 years old, since these erupt early and take the brunt of falls and sports injuries.
How is Apexification in Kids Performed? Step-by-Step
The apexification in pediatric dentistry procedure typically involves three main steps, usually spread across two to four visits depending on how quickly the barrier forms:
Step 1: Cleaning the Infection
The dentist gently removes the infected or dead pulp tissue and disinfects the canal thoroughly to eliminate bacteria.
Step 2: Placing a Barrier-Forming Material
A biocompatible material — most commonly Mineral Trioxide Aggregate (MTA) or, in some protocols, calcium hydroxide — is placed inside the canal. MTA is now the preferred choice in most cases because it forms a barrier faster (often in a single visit) and has a strong success record. Calcium hydroxide works over several months but has traditionally been used for its antibacterial effect.
Step 3: Sealing the Tooth
Once the barrier has formed and is confirmed on an X-ray, the canal is filled and the tooth is restored with a filling or crown to protect the now-thin, brittle walls from fracture.
Will Apexification Hurt My Child?
No. The procedure is performed under local anesthesia, and at Kidz N Teenz we combine this with gentle, child-friendly behavior management so your child stays calm and comfortable throughout. Most children report only mild sensitivity for a day or two afterward, similar to a routine filling.
Benefits of Dental Apexification for Kids
The benefits of apexification in pediatric dentistry go well beyond saving one tooth. Preserving a young permanent tooth supports:
- Speech development — front teeth are essential for certain sounds
- Chewing function — especially important during growth years
- Facial and jaw growth — early tooth loss can affect bone development
- Confidence and appearance — especially relevant for visible front teeth
- Space maintenance — keeping the natural tooth avoids the need for space maintainers or later orthodontic correction
Recovery and Aftercare
After treatment, most children return to normal activities the same day. To support healing:
- Avoid biting hard foods directly on the treated tooth for the first few days
- Maintain regular brushing and flossing, being gentle around the treated area
- Attend all follow-up visits — the barrier is checked with X-rays over several months
- Report any new swelling, pain, or looseness immediately
Success Rate and What Happens If the Barrier Doesn’t Form
Apexification has a high success rate — most studies report 80–95% success in achieving a sealed apical barrier. In the small number of cases where the barrier doesn’t form fully, the dentist may repeat the MTA placement or, in select cases, refer the tooth for surgical treatment. Left completely untreated, an infected immature tooth can lead to abscess formation, bone loss around the root, and eventual tooth loss — which is why early evaluation matters.
A Newer Alternative: Regenerative Endodontics
In some children, instead of forming an artificial barrier, dentists may attempt regenerative endodontic treatment, which tries to encourage the tooth’s own root to keep developing using the child’s own blood-clot-based healing response. This isn’t suitable for every case, but it’s worth asking your pediatric dentist whether your child is a candidate.
Cost of Apexification for Permanent Teeth in Children
The cost of apexification for permanent teeth in children varies depending on the number of visits required, the material used (MTA is generally costlier than calcium hydroxide), and whether a crown is needed afterward. Because this is a multi-visit procedure with X-ray monitoring built in, it’s best evaluated after an in-person examination. Contact our clinic for a personalized cost estimate for your child.
Why Choose Kidz N Teenz for Your Child’s Apexification
Delaying treatment for an injured or infected young tooth increases the risk of losing it permanently. At Kidz N Teenz, our pediatric dental specialists are trained specifically in managing dental trauma and pulp complications in growing children, using modern materials and a gentle, child-first approach. If your child has recently experienced dental trauma or shows signs of infection in a young permanent tooth, our emergency dental care and restorative dentistry teams can evaluate and begin treatment promptly.
Conclusion
In conclusion, apexification in pediatric dentistry is a vital, minimally invasive procedure for preserving infected or injured immature permanent teeth in children. By encouraging a calcified barrier to form at the root tip, it allows the tooth to be sealed, heal properly, and continue functioning normally. With timely intervention and expert pediatric care, apexification can prevent early tooth loss and support healthy oral development as your child grows.
